MODELS OF CARE CSIRO PUBLISHING

Australian Health Review, 2014, 38, 265–270 http://dx.doi.org/10.1071/AH13232

Effect of weekend physiotherapy provision on physiotherapy and hospital length of stay after total knee and total hip replacement Zoe L. Maidment1,2 BPhty, MClinRehabil, Physiotherapist Brenton G. Hordacre2 BPhty(Hons), PhD Student Christopher J. Barr2,3 BSc(Hons), MRes, PhD, Lecturer 1

Queensland Health, Bundaberg Hospital, Bourbong Street, Bundaberg, Qld 4670, Australia. Email: [email protected] 2 Flinders University, Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, SA 5041, Australia. Email: [email protected] 3 Corresponding author. Email: chris.barr@flinders.edu.au

Abstract Objective. The aim of the present study was to investigate a change in physiotherapy provision from a 5- to 7-days-aweek service on both physiotherapy and hospital length of stay (LOS) after total knee (TKR) and total hip (THR) replacement. Methods. A retrospective analysis of a clinical database was conducted for patients who received either a TKR or THR between July 2010 and June 2012 in one regional hospital. Results. There was a significant decrease in physiotherapy LOS from 5.0 days (interquartile range (IQR) 5.0–6.0 days) for a 5-day physiotherapy service, to 5.0 days (IQR 4.0–5.0 days) for 7-day physiotherapy service (U = 1443.5, z = –4.62, P = 0.001). However, hospital LOS was not reduced (P = 0.110). For TKR, physiotherapy LOS decreased significantly by 1 day with a 7-day physiotherapy service (U = 518.0, z = –4.20, P = 0.001). However, hospital LOS was again no different (P = 0.309). For THR there was no difference in physiotherapy LOS (P = 0.060) or hospital LOS (P = 0.303) between the 5- and 7-day physiotherapy services. Where physiotherapy LOS was less than hospital LOS, delayed discharge was due primarily to non-medical issues (72%) associated with hospital organisational aspects. Conclusions. Increasing the provision of physiotherapy service after TKR provides an increase in physiotherapy sessions and has the potential to reduce hospital LOS. To be effective this must align with other administrative aspects of hospital discharge. What is known about the topic? Previous studies have investigated the effect of increasing physiotherapy services following total hip replacement (THR) and total knee replacement (TKR) surgery, with varying reports of decreased or unaffected hospital length of stay (LOS). What does this paper add? This study investigates both hospital and physiotherapy LOS individually for THR and TKR patients following an increase from a 5- to 7-day physiotherapy service. Where physiotherapy LOS decreased and hospital LOS did not, delays in hospital discharge were investigated. What are the implications for practitioners? Additional physiotherapy services decrease physiotherapy LOS for TKR patients, but administrative aspects of hospital discharge must improve to reduce hospital LOS. Received 5 December 2013, accepted 18 February 2014, published online 8 May 2014

Introduction Global trends of obesity and reduced physical activity have led to increased chronic lifestyle diseases, reducing physical capacity and increasing cost on the healthcare system.1–3 Total joint replacement surgery is commonly performed for hip and knee joints and is successful in reducing pain and restoring function.4,5 The Australian Orthopaedic Association National Joint Replacement Registry 2013 annual report found that the number of total Journal compilation Ó AHHA 2014

hip replacement (THR) surgeries increased by 0.1% on the previous year, whereas the number of total knee replacement (TKR) surgeries increased by 2.7% on the previous year.6 These numbers have grown annually, with increases of 40.9% for THR and 69.1% for TKR since 2003, and it is suggested they will continue to grow into the future.6 Joint replacement surgery is expensive, although cost-effectiveness analysis has demonstrated that the quality of life gained www.publish.csiro.au/journals/ahr

266

Australian Health Review

justifies the expense.4,7 However, as the number of THR and TKR surgeries performed increases, there is an increasing demand on hospital bed space. The growth of joint replacement surgery has meant that much research has been conducted to ensure that orthopaedic and physiotherapy services are providing efficient and effective treatment to ensure length of stay (LOS) is kept to a minimum. With advances in surgical techniques, pain management and physiotherapy interventions there is a continual drive to reduce hospital LOS associated with joint replacement surgery in order to not only ensure availability of hospital bed space, but also reduce overall costs.8–11 The most significant cost for many healthcare systems in the developed world relates to LOS.12 Although medical and nursing professions traditionally provide 24-h care, there is a large amount of variability in the level of service physiotherapy provides to patients after total joint replacement, and there is now increasing interest on the impact of increased physiotherapy services, particularly weekend services, on LOS.13 The main aim of expanding physiotherapy services through implementation of weekend physiotherapy services is to reduce LOS. However, research is inconclusive as to its effectiveness, with suggestions of both reduced LOS14–16 and no difference in LOS.13,17,18 It is believed that 5-day physiotherapy services may delay discharge, with reduced therapy input or capacity to discharge across the weekend. However, several factors not associated with physiotherapy services may affect LOS, including age,19–21 gender,20,21 comorbidities19,20 and surgical incision length.8,22 To our knowledge, no previous studies have reported the effect of 7-day physiotherapy on both LOS and physiotherapy LOS in order to determine whether there is a difference in these two measures. Investigation of the effect of 7-day physiotherapy on both physiotherapy LOS and hospital LOS may provide insight to the complex nature of hospital service provision following THR and TKR surgery. The primary aim of the present study was to investigate the effect the change in physiotherapy service provision from 5 days a week to 7 days a week has on both hospital LOS and physiotherapy LOS. A secondary aim of the present study was to determine factors that may delay discharge from hospital once a patient has been discharged from physiotherapy. We hypothesised that 7-day-a-week physiotherapy service would reduce physiotherapy LOS, but not hospital LOS. Methods Design A retrospective analysis of a clinical database was conducted for patients who received either a TKR or THR between July 2010 and June 2012 in one regional hospital in Queensland, Australia. Ethics approval was granted by both the Executive Sponsors at the hospital and the Southern Adelaide Clinical Human Research Ethics Committee. Setting and participants In all, 145 consecutive patients who underwent a TKR or THR in an orthopaedic ward at one regional hospital in Queensland, Australia, were recruited to the study. Prior to July 2011, a 5-day physiotherapy service was provided for TKR and THR. Since July 2011, this service was increased to a 7-day physiotherapy service. Physiotherapy rehabilitation for TKR and THR remained

Z. L. Maidment et al.

consistent across the observation period and included range of motion exercises, lower limb strengthening exercises, gait reeducation, balance exercises and gait aid prescription where required. With the exception of six cases, all surgical procedures were conducted on Wednesdays by one of two surgeons. Two cases were performed on a Monday and four on a Thursday. Outcome measures Physiotherapy LOS was defined as the number of nights spent in hospital from admission to the time a physiotherapist documented that the patient was suitable for discharge. Hospital LOS was defined as the number of nights from admission to discharge. The difference in physiotherapy LOS and hospital LOS was calculated and, where hospital LOS was greater, the reasons for delayed discharge were identified. These reasons for delay in discharge were categorised as non-medical or medical. Non-medical reasons for discharge delay included organisational factors (difficulties or failures in communication within the healthcare team and a decision by the orthopaedic team to delay discharge so that a 5-day follow-up assessment could be conducted as an in-patient rather than as an out-patient) and personal factors (e.g. a patient’s inability to obtain transport for discharge). Medical reasons for discharge delay were due to unforeseen medical complications such as bowels not open, chest infections, requirement for blood transfusions and other health professions considering the patient not to be safe and ready for discharge. Analysis Normality of data was tested with a Shapiro–Wilk normality test. Age and LOS data were not normally distributed, therefore nonparametric statistics were applied. Descriptive statistics were used to describe the demographics and clinical characteristics of participants admitted to the study. Statistical differences between the 5-day and 7-day physiotherapy services were analysed for participant demographics and clinical characteristics using either a Mann–Whitney U-test for median and interquartile range (IQR) for age, or a Chi-squared test (for gender, type of surgery, gait aid use before surgery). Statistical differences between the 5- and 7-day physiotherapy services overall, and individually for TKR and THR, were analysed for the outcome measures of physiotherapy LOS (PLOS), hospital LOS (HLOS). Differences between PLOS and HLOS were analysed with individual Mann–Whitney U-tests for median and IQR. Nonmedical or medical reasons for delayed discharge were analysed using descriptive statistics. The level of statistical significance was set at P  0.05. Data were analysed using IBM SPSS Statistics for Windows, version 19 (released 2010; IBM Corp., Armonk, NY, USA). Results In all, 145 patients underwent elective total joint replacement surgery over a 2-year period. Most patients had TKR surgery (63%) and were female (57%). The median age of participants admitted to the study was 70.0 years (IQR 65.0–75.0 years). Participant demographics and clinical characteristics are given in Table 1. As expected, introduction of a 7-day physiotherapy service significantly increased the median number of physiotherapy sessions provided to patients from 5.0 (IQR 5.0–7.0) to 7.0

Weekend physiotherapy reduces physiotherapy LOS

Australian Health Review

267

Table 1. Participant demographics and clinical characteristics for both the 5- and 7-day physiotherapy services for both total knee replacement (TKR) and total hip replacement (THR) combined Unless indicated otherwise, data show the number of patients in each group, with percentages in parentheses. IQR, interquartile range

Median (IQR) age (years) % Women TKR THR Gait aid use before surgery (%)

5-Day physiotherapy service (n = 59)

7-Day physiotherapy service (n = 86)

P-value

70.0 (67.0–78.0) 49% 40 (67.8%) 19 (32.2%) 50.8%

69.0 (64.8–74.0) 62% 51 (59.3%) 35 (40.7%) 54.7%

0.098 0.137 0.299 0.299 0.652

Table 2. Demographics and clinical outcomes for total knee replacement surgery subjects in the 5- and 7-day physiotherapy services Unless indicated otherwise, data show median values with the interquartile range in parentheses. LOS, length of stay; PT, physiotherapy. *Statistically significant at P  0.05 5-Day physiotherapy 7-Day physiotherapy P-value service (n = 40) service (n = 51) Age (years) % Women No. PT sessions PT LOS (days) Hospital LOS (days)

70.5 (68.0–78.0) 53% 6.0 (5.0–7.0) 6.0 (5.0–6.0) 6.0 (5.0–7.0)

69.0 (64.0–74.0) 63% 7.0 (6.0–9.0) 5.0 (4.0–6.0) 6.0 (5.0–6.0)

0.121 0.325 0.005* 0.001* 0.309

Table 4. Summary of the reasons for delayed discharge from hospital after physiotherapy clearance Category Unforeseen Awaiting transition care program Orthopaedic protocol Poor planning Communication Complex patient – expected

No. patients (%) 15 (10.3) 4 (2.8) 24 (16.6) 6 (4.1) 14 (9.7) 1 (0.7)

Delays in discharge Table 3. Demographics and clinical outcomes for total hip replacement surgery subjects in the 5- and 7-day physiotherapy services Unless indicated otherwise, data show median values with the interquartile range in parentheses. *Statistically significant at P  0.05. LOS, length of stay; PT, physiotherapy 5-Day physiotherapy 7-Day physiotherapy P-value service (n = 40) service (n = 51) Age (years) % Women No. PT sessions PT LOS (days) Hospital LOS (days)

69.0 (66.0–77.0) 42% 5.0 (5.0–7.0) 5.0 (5.0–6.0) 5.0 (5.0–6.0)

69.0 (65.0–75.0) 60% 6.0 (6.0–8.0) 5.0 (4.0–5.0) 5.0 (5.0–6.0)

0.568 0.208 0.050* 0.060 0.303

(IQR 6.0–8.0) sessions (U = 1738.0, z = –3.27, P = 0.001). There was a significant decrease in the median PLOS from 5.0 (IQR 5.0– 6.0) days for the 5-day physiotherapy service, to 5.0 (IQR 4.0– 5.0) days for the 7-day physiotherapy service (U = 1443.5, z = –4.62, P = 0.001). However, this did not translate into reduced HLOS (P = 0.110). Median HLOS for the 5- and 7-day physiotherapy services was 6.0 (IQR 5.0–7.0) and 5.0 (IQR 5.0–6.0) days, respectively. To further understand the impact of 7-day physiotherapy services, we analysed LOS outcomes separately for TKR and THR surgery. For TKR surgery, median PLOS was significantly reduced by 1 day with the 7-day physiotherapy service (U = 518.0, z = –4.20, P = 0.001). However, HLOS was again no different (P = 0.309). For THR surgery there was no difference in median PLOS (P = 0.060) or HLOS (P = 0.303) between the 5- and 7-day physiotherapy services. Patient demographics and clinical outcomes for TKR and THR are provided individually in Tables 2 and 3, respectively.

Overall, 45% (n = 65) of participants had HLOS greater than PLOS. As expected, these episodes were predominantly in the 7-day-a-week physiotherapy program (74%). In most cases (72%), non-medical issues contributed to the delay in discharge from hospital. These non-medical issues were primarily the result of hospital organisational issues (91%). The reasons for delayed hospital discharge after physiotherapy clearance are summarised in Table 4. Discussion The present study has revealed several findings important for hospital service and efficiency of TKR and THR patients. First, the addition of a 7-day-a-week physiotherapy service resulted in an increase in the number of physiotherapy sessions provided to patients, indicating that this service change was effective in targeting THR and TKR patients who had their surgery predominantly on Wednesday. Second, 7-day physiotherapy sessions reduced PLOS, but not HLOS. Third, further analysis for PLOS revealed that the reduction was only evident in patients who had a TKR, and not THR, suggesting that additional physiotherapy may only benefit patients with TKR surgery. Finally, there were multiple reasons for delays to discharge, including administrative factors and patient health-related issues. However, addressing these hospital administration procedures may allow the addition of a 7-day physiotherapy service to reduce HLOS, potentially reducing associated costs and improving bed space availability. These findings and their significance to the physiotherapy efficiency and service of THR and TKR patients is discussed below. In the present study, the provision of 7-day physiotherapy services resulted in more physiotherapy sessions, suggesting that the intent of increasing physiotherapy services was effective. Previous studies have found that increasing therapy dose is

268

Australian Health Review

effective in reducing LOS and improving patient outcomes.8,23–25 However, several studies have investigated alternative methods to increase therapy dose, such as prolonging therapy duration26 or providing additional sessions per day.9,27 Findings from these studies indicate that there was no change in LOS,9,26,27 but some improvements in functional outcomes, such as frequency of falls26 and achievement of functional milestones.9 These findings possibly indicate that there is a limit as to the amount of therapy these patients can tolerate. The finding that PLOS decreased as a result of 7-day physiotherapy but HLOS did not suggests that other levels of hospital efficiency must improve before the effect of physiotherapy is translated to HLOS. The biggest cause of increased LOS after physiotherapy discharge was due to patients staying in hospital until they had a Doppler ultrasound, scheduled for post-operative Day 5. This was because for some patients it was more convenient to stay in hospital than to be discharged and return as an out-patient for this procedure. Poor communication and poor planning were also potentially preventable reasons for delayed discharge, accounting for one-third of the time discharge was delayed. This is a significant failing in the system that can be easily rectified with improvements in communication processes. Fewer than one-quarter of the reasons for delayed discharge were unavoidable with process changes. Simple changes to organisational factors could make a great impact on LOS. Previous studies have demonstrated that HLOS remains unchanged following the introduction of 7-day physiotherapy services.13,17,18 However, it is established that additional physiotherapy results in functional improvements,9,23,24 improved ability to perform independent transfers18 and improved quality of life at discharge,23,24 suggesting that improvements in LOS should be found. The inability to demonstrate a reduction in LOS in these previous studies may relate to methodological constraints. A greater proportion of discharge delays in the 7-day physiotherapy intervention group may potentially bias results and contribute to a non-significant finding.18 In addition, one study reporting no difference in LOS for a 6- versus 7-day physiotherapy service did not consider the implications that a range of days when surgery was performed may have on the results.17 In that study, 50% of THR and TKR surgery was performed on a Monday and Tuesday, with the remaining 50% performed later in the week. Given the median LOS of 5 days following both THR and TKR surgery, it appears the addition of Sunday services may have no benefit for patients in whom surgery was performed earlier in the week.17 In the present study, surgery was predominantly performed on Wednesday, and therefore the addition of weekend physiotherapy would be a service able to be used by the majority of patients. Here, we were able to compare PLOS and HLOS to determine that PLOS does, indeed, reduce as a result of 7-day physiotherapy services. Although previous studies have reported a reduction in HLOS,14,16 we were unable to replicate these findings. As with many hospital service delivery modifications, a reduction in HLOS is a significant outcome due to the ability to free bed space and reduce associated costs. To achieve a reduction in HLOS, we suggest that organisational delays within hospitals would need to be minimised. In light of our results and those discussed previously, we suggest that 7-day physiotherapy services have more potential to reduce LOS compared with

Z. L. Maidment et al.

increasing therapy dose through longer physiotherapy session or providing additional sessions per day. Further analysis of our data showed that the reduction in PLOS occurs only for TKR and not THR patients. It is difficult to determine why this is the case from our data. One explanation may be that we had fewer patients in our THR group, potentially making the study underpowered. A post hoc power calculation revealed that, for a power of 0.8, 17 participants would be needed in each THR group (n = 34) to detect a significant change of 1 day LOS, given a standard deviation of 1 day. We are therefore confident that our result is genuine. An alternative explanation may be that TKR results in greater postoperative pain compared with THR,28 suggesting that additional physiotherapy may benefit TKR patients. In addition, it has been reported that THR results in greater patient satisfaction, requiring less physiotherapy intervention,29 compared with TKR surgery, which requires greater physiotherapy input and a longer time to achieve the same mobility levels.29 Many hospital services also stipulate that TKR patients must meet a minimum range of motion of the knee joint before discharge.30 Typically, this requirement is not applied to THR patients and therefore additional physiotherapy may assist TKR patients achieving this earlier. Finally, from a physiotherapy perspective, achieving a reduction in LOS for THR patients may require early mobilisation after surgery and specialised as opposed to generalised physiotherapy rehabilitation classes.31 Although the present study demonstrated a reduction in PLOS for TKR patients, this was not translated into a reduction in HLOS and we therefore suggest there was no associated reduction in hospital costs and bed space availabilities. Indeed, there may have been an increased hospital cost associated with additional staffing requirements to provide weekend physiotherapy service. It is important that additional physiotherapy intervention does in fact decrease HLOS because it does come at a cost, so careful attention must be taken to ensure that there is a financial benefit, which, in turn, may result in savings to the health service or the ability to provide additional services.13 The delays in discharge identified in here have been confirmed previously, with other studies also suggesting that hospital administration and organisational delays contribute to delayed discharge in some TKR and THR patients.18,32 It has also been suggested that pain, dizziness and general weakness may contribute to delayed discharge.32 However, it is difficult to conclude that as being a contributing factor in this cohort given that the patients were discharged from physiotherapy and were therefore considered to be safe with mobility and transfers, suggesting that pain, weakness and dizziness were not contributing factors. Therefore, we suggest that to translate benefits of reduced PLOS, hospital administration and organisation factors must also improve efficiency to prevent delayed discharges. Future studies should continue to investigate improvements to hospital efficiency in service provision for THR and TKR patients, with a particular focus on improving administration and organisational factors. Limitations This study has several limitations. First, the study was retrospective in nature and the accuracy of the recorded information is reliant upon the quality of documentation and recoding within the database and medical notes. Second, this study was based at a

Weekend physiotherapy reduces physiotherapy LOS

single site and there are likely to be variations in service provision, admission and discharge requirements at different sites. Therefore, data from this study may not be generalisable to other joint replacement patient populations. In addition, data recorded within the clinical database did not include all factors that may impact on LOS, the primary outcome in the present study. Factors that may influence HLOS would include surgical incision length, medical comorbidities, pain score and provision of pain relief medication. Finally, a randomised control study design would be more appropriate for studies of this nature and future studies should consider implementation of this study design. Given the change in hospital service provision was determined by hospital-based administrators, a randomised controlled trial was not appropriate in this case.

Conclusion Increasing the provision of physiotherapy service after TKR provides an increase in physiotherapy sessions and has the potential to reduce HLOS; however, for this to be effective this service must align with other administrative aspects of hospital discharge. Increasing physiotherapy service after THR does not result in an earlier discharge, likely because TKR patients require greater physiotherapy input compared with THR patients. Future studies should investigate the improvement of hospital administrative and organisational factors in addition to increased physiotherapy services to reduce HLOS, and subsequently reduce hospital costs and increase bed space availability.

References 1

2

3 4

5

6

7

8

9

Manson JE, Skerrett PJ, Greenland P, VanItallie TB. The escalating pandemics of obesity and sedentary lifestyle: a call to action for clinicians. Arch Intern Med 2004; 164: 249–58. doi:10.1001/archinte.164.3.249 Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA 1999; 282: 1523–9. doi:10.1001/jama.282.16.1523 Burton BT, Foster WR. Health implications of obesity: an NIH consensus development conference. J Am Diet Assoc 1985; 85: 1117–21. Segal L, Day SE, Chapman AB, Osborne RH. Can we reduce disease burden from osteoarthritis? An evidence-based priority-setting model. Med J Aust 2004; 180(Suppl.): S11–17. Jones CA, Voaklander DC, Johnston D, Suarez-Almazor ME. Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. J Rheumatol 2000; 27: 1745–52. Australian Orthopaedic Association (AOA). Australian Orthopaedic Association National Joint Replacement Registry annual report 2013. Adelaide: AOA; 2013. Jenkins PJ, Clement ND, Hamilton DF, Gaston P, Patton JT, Howie CR. Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. J Bone Joint Surg Am 2013; 95B: 115–21. doi:10.1302/0301-620X.95B1.29835 Peck CN, Foster A, McLauchlan GJ. Reducing incision length or intensifying rehabilitation: what makes the difference to length of stay in total hip replacement in a uk setting? Int Orthop 2006; 30: 395–8. doi:10.1007/s00264-006-0091-1 Stockton KA, Mengersen KA. Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial. Arch Phys Med Rehabil 2009; 90: 1652–7. doi:10.1016/j.apmr.2009.04.012

Australian Health Review

269

10 Ilfeld BM, Mariano ER, Girard PJ, Loland VJ, Meyer RS, Donovan JF, et al. A multicenter, randomized, triple-masked, placebo-controlled trial of the effect of ambulatory continuous femoral nerve blocks on discharge-readiness following total knee arthroplasty in patients on general orthopaedic wards. Pain 2010; 150: 477–84. doi:10.1016/ j.pain.2010.05.028 11 Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery. A case study of 325 patients. Acta Orthop 2008; 79: 174–83. doi:10.1080/17453670710014950 12 Feachem RGA, Dixon J, Berwick DM, Enthoven AC, Sekhri NK, White KL. Getting more for their dollar: a comparison of the NHS with California’s Kaiser Permanente Commentary: funding is not the only factor commentary: Same price, better care Commentary: Competition made them do it. BMJ 2002; 324(7330): 135–43. doi:10.1136/ bmj.324.7330.135 13 Brusco NK, Paratz J. The effect of additional physiotherapy to hospital inpatients outside of regular business hours: a systematic review. Physiother Theory Pract 2006; 22: 291–307. doi:10.1080/095939806010 23754 14 Pua YH, Ong PH, Chong HC, Lo NN. Sunday physiotherapy reduces inpatient stay in knee arthroplasty: a retrospective cohort study. Arch Phys Med Rehabil 2011; 92: 880–5. doi:10.1016/j.apmr.2011.01.009 15 Freburger JK. An analysis of the relationship between the utilization of physical therapy services and outcomes of care for patients after total hip arthroplasty. Phys Ther 2000; 80: 448–58. 16 Hughes K, Kuffner L, Dean B. Effect of weekend physical therapy treatment on postoperative length of stay following total hip and total knee arthroplasty. Physiother Can 1993; 45: 245–9. 17 Lang CE. Comparison of 6- and 7-day physical therapy coverage on length of stay and discharge outcome for individuals with total hip and knee arthroplasty. J Orthop Sports Phys Ther 1998; 28: 15–22. doi:10.2519/jospt.1998.28.1.15 18 Boxall AM, Sayers A, Caplan GA. A cohort study of 7 day a week physiotherapy on an acute orthopaedic ward. Orthop Nurs 2004; 8: 96–102. doi:10.1016/j.joon.2004.03.004 19 Cullen DJ, Apolone G, Greenfield S, Guadagnoli E, Cleary P. ASA physical status and age predict morbidity after three surgical procedures. Ann Surg 1994; 220: 3–9. doi:10.1097/00000658-199407000-00002 20 Epps CD. Length stay, discharge disposition, and hospital charge predictors. AORN J 2004; 79: 975–97. doi:10.1016/S0001-2092(06) 60729-1 21 Hayes JH, Cleary R, Gillespie WJ, Pinder IM, Sher JL. Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty? J Arthroplasty 2000; 15: 448–52. doi:10.1054/ arth.2000.4346 22 Chung WK, Liu D, Foo LS. Mini-incision total hip replacement: surgical technique and early results. J Orthop Surg (Hong Kong) 2004; 12: 19–24. 23 Parker A, Lord R, Needham D. Increasing the dose of acute rehabilitation: is there a benefit? BMC Med 2013; 11: 199. doi:10.1186/1741-7015-11-199 24 Peiris CL, Shields N, Brusco NK, Watts JJ, Taylor NF. Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomized controlled trial. BMC Med 2013; 11: 198. doi:10.1186/1741-7015-11-198 25 Peiris C, Taylor N, Shields N. Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: a systematic review. Arch Phys Med Rehabil 2011; 92: 1490–500. 26 Bischoff-Ferrari HA, Dawson-Hughes B, Platz A, Orav EJ, Stähelin HB, Willett WC, et al. Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Arch Intern Med 2010; 170: 813–20. doi:10.1001/ archinternmed.2010.67

270

Australian Health Review

Z. L. Maidment et al.

27 Lenssen AF, Crijns YH, Waltje EM, van Steyn MJ, Geesink RJ, van den Brandt PA, et al. Efficiency of immediate postoperative inpatient physical therapy following total knee arthroplasty: an RCT. BMC Musculoskelet Disord 2006; 7: 71. 28 Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, Moric M, et al. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop 2012; 36: 2261–7. doi:10.1007/ s00264-012-1623-5 29 de Beer J, Petruccelli D, Adili A, Piccirillo L, Wismer D, Winemaker M. Patient perspective survey of total hip vs total knee arthroplasty surgery. J Arthroplasty 2012; 27: 865–9.e5. doi:10.1016/j.arth.2011.12.031

30 Naylor J, Harmer A, Fransen M, Crosbie J, Innes L. Status of physiotherapy rehabilitation after total knee replacement in australia. Physiother Res Int 2006; 11: 35–47. doi:10.1002/pri.40 31 Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, et al. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch Orthop Trauma Surg 2010; 130: 263–8. doi:10.1007/s00402-009-0940-7 32 Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop 2011; 82: 679–84. doi:10.3109/17453674.2011.636682

www.publish.csiro.au/journals/ahr

Effect of weekend physiotherapy provision on physiotherapy and hospital length of stay after total knee and total hip replacement.

The aim of the present study was to investigate a change in physiotherapy provision from a 5- to 7-days-a-week service on both physiotherapy and hospi...
121KB Sizes 0 Downloads 4 Views